Gelmann:
Bob's laboratory always worked more or less as a sole agent, relying on
collaborators who brought in samples. There was not a whole lot of collaboration
with the virology laboratory at the CDC that was headed by [Dr. Cirilo]
Cy Cabradilla. If he did not head it, he was intensely involved in it.
There were other collaborators who brought specimens and exchanged materials
with Gallo, but there was no extensive collaboration with the CDC. I think
the big exchange of materials or activity went on after I had left the
laboratory. There is this famous story told about the 200 samples which
Gallo was given blinded and how he was able to identify them based on
the new serologic tests which had been developed from the viral reagents
that [Dr. Mikulas] Popovic and [Dr. M. G.] Sarngadharan had isolated.

Rodrigues:
Another thing that we have come across in our research was your name listed
next to a series of different projects that NIH was initiating, some of
which had to do with an efficacy study of human lymphoblastoid interferon
in Kaposi's sarcoma.

Gelmann: What happened in the
middle of 1983 was that I was in the process of making a career move,
regardless of AIDS. It happened to fall right in the middle of the AIDS
excitement. This was just after we published our papers in Science
and had gone to the meeting in Cold Spring Harbor. I was packing
up my stuff and moving to Building 10 when [Dr.] Françoise Barré-Sinoussi
was visiting the laboratory after the Cold Spring Harbor meeting. She
had come down to Bethesda and brought samples with her. I had made a decision
completely independently to take a senior staff position in the Medicine
Branch and return to doing a little more of clinical activities. Because
of that move, my activities changed from doing laboratory research in
AIDS to being involved in some of the clinical programs.

There was a desire to establish clinical programs like those I was involved
in in the National Cancer Institute. So we decided to focus our activities
on the cancer aspect of AIDS, which was Kaposi's sarcoma. I was involved
in those trials–when they began I was still in Gallo's laboratory–and
had a commitment to go to the Medicine Branch. We also felt that it would
give us an opportunity to collect our own patients and that those patients
would provide us with the ability to learn about disease and collect samples.
Since interferon was being used in Kaposi's sarcoma, we thought it would
be a good idea to test whether it had some antiviral properties as well
as antiproliferative properties. I became the principal investigator of
that trial and then we began to accrue patients. I continued that Kaposi's
work when I moved to Building 10.

Rodrigues: About how much longer
did you pursue that?

Gelmann: I
was involved with clinical AIDS work for about a year or two after I moved
to Building 10. That was very much of an inter-branch collaboration. We
had a large number of patients in the clinical studies and also a number
of on-going ancillary laboratory studies. There was a cadre of research
nurses, fellows, and other people who were interested in their care. Every
week, [Dr. H. Clifford] Cliff Lane, [Dr.] Henry Masur and I sat down in
a large conference room with all of the ancillary staff and went through
[the records of] each and every patient who was on the various studies
of the Clinical Center, NIAID, and the NCI. When patients were done with
one study and appropriate for another, we transitioned their care. Laboratory
workers from the FDA [Food and Drug Administration] and from elsewhere
would come and give reports on viral testing, on reagents, what we needed
to do, what we could give them and so on. That was a very rich and fruitful
time for collaboration. An ad hoc AIDS working group sprang out of those
meetings. That was from the initiative of Lane, Masur, and myself. We
got together and started seeing patients on the ward, but then it would
become overwhelming, so we sat down in the room once a week. Out of that
came, for me, nearly fifteen or twenty papers. It was just a tremendous
collaboration and where all those publications in my curriculum vitae
come from.

Rodrigues:
Maybe you could say a little more about how that AIDS working group evolved.
It was confusing when we looked through the records since there were many
different groups of people that seemed to come together for different
purposes.

Gelmann: From
my point of view, it evolved strictly out of the needs of clinicians trying
to deal with the increasing number of patients. Henry was quite an expert
in the clinical management; Cliff was working with Tony [Dr. Anthony]
Fauci and had some new reagents that he wanted to try; and we were collecting
our own patients to look at Kaposi's sarcoma. The clinical aspects of
AIDS were pretty new and we did not know that much. So we were constantly
consulting with each other while seeing patients on the ward. But as more
and more patients came, the burden became so overwhelming that we just
had to sit down and do it in an orderly fashion. In addition, so many
other investigators were asking for blood, urine, and other samples, that
we felt that the best way to do that was to coordinate this through a
single meeting. That way, various protocols and requirements for different
sample acquisition could be met, patient care would be optimized, and
then patients who were done with one study could move on to another if
they were eligible. It was really a grass-roots effort that just sprang
out of the needs of the people who were involved.

Harden: What
about your staff–the nurses, technicians and other people? Were
you getting any particular feedback from them in terms of direct patient
care and their concerns about AIDS?

Gelmann: In
the research staff, everyone in this working group was dedicated and I
guess we just accepted by observation that this was no more contagious
than hepatitis B. We were careful, but not paranoid. Certainly we dealt
with these patients and their materials carefully, but basically in the
same way as we would for a patient with hepatitis. There was some greater
concern among the general nursing staff, and it was addressed directly
in meetings. The one thing we did early on was to proscribe contact of
pregnant medical personnel with patients, because we knew that the patients
were carriers and shedders of cytomegalovirus. That represented a potential
threat to a fetus. There has been a lot written about regulations in handling
and universal precautions. There has been a lot of adaptation, and also
recommendations have come out of the CDC, but, fundamentally, not much
has changed for us, since we took precautions from day one. Fundamentally,
AIDS still has a similar transmission pattern to hepatitis B.

Harden: What
about the behavior of the patients?

Gelmann: It
was something we adapted to. To my recollection, there was not in our
clinical activities, any specific support or focus on psychosocial aspects
of AIDS care. I do not remember whether we did not have the personnel
or whether we were too busy.

Harden: Were
the patients generally cooperative?

Gelmann: Immensely.
They were one of the heroic stories of the whole AIDS saga. Initially,
most of those patients were homosexual men and one of the great stories
of the AIDS saga has been the response of the gay community: active, well
informed, cooperative, supportive to each other and not particularly enjoying
dying young. It is my personal belief that the AIDS activists, in terms
of the experimental drug issue, have done all of us a favor, and cancer,
sooner or later, is going to benefit from the model of the AIDS activists.
In fact, there is now a group for cancer survivors being formed and becoming
more vocal. It was the AIDS activists that taught us how to do that.

Rodrigues:
As the work on AIDS began to expand, were there problems for you and your
staff in terms of support, or did you find that the resources that you
needed to carry out research and to expand this effort were forthcoming?

Gelmann: Intramurally,
there was always too much money. My personal viewpoint–it is strictly
my opinion–was that extramurally for a while, there was also too
much money. This was a tremendous problem. People had to throw money at
AIDS, because only then did the bureaucrats and legislators think that
something was being done, and then the money came too fast. We could not
adapt; we could not learn how to spend it as fast as it was coming.

Rodrigues:
Now, you say that was true even for the intramural program at that time.

Gelmann: It
is my personal view, that for the extramural program, it was true that
when all of a sudden there was a tremendous expansion of the AIDS dollars,
there was a lot of money that went to projects that were not properly
conceived. It takes time to figure out how to spend the money and what
experiments to do. But the public demanded that money be spent; that the
problem be solved. That has changed. We went through a growing period,
things evolved and there has been some incredibly useful work coming out
of the studies of HIV at many levels. It has tightened up, now. But in
the beginning, there was a huge waste.

Harden: We
can take this one step further for a philosophical question about the
public's view, the physicians, and scientific medicine. Do you think we
can just pour money into a problem and a solution must be forthcoming,
and, furthermore, if it is not, then anger is justified?

Gelmann: The
understanding is forthcoming, and you do not need AIDS for that. I mean,
look at sickle-cell anemia. We understand that down to the atomic level.
So, the understanding is forthcoming. AIDS patients have certainly benefited.
For example, AZT [3'-Azido-2', 3'-dideoxythymidine] basically came out
of the intramural NCI program. AIDS testing of the blood supply is, after
all, essentially safe. Just think, right now if we had no serologic tests,
we could not guarantee our blood supply. What a disaster! There have been
some major advances with this. We are learning about this virus. We have
known about influenza much longer and have yet to be able to figure out
how to make a vaccine that is useful for more than one season. We may
have to wind up re-vaccinating people for the AIDS virus once we figure
out which people we should vaccinate. But we have learned a lot in general
about retroviruses from the work. The technical expertise that has poured
into this and the biotechnology is wonderful. This will have ramifications
for many different fields. This is not just AIDS. When you get down to
such fundamental issues in biology, there is always spillover.

Rodrigues:
You can look at the spillover of where things will go in the future, in
terms of what we are learning, by looking at AIDS. The other part that
a lot of people tend to discount is the work that was done immediately
preceding the emergence of AIDS. For instance, look at all the work on
HTLV-I and the techniques of cloning genes.

Gelmann: I
am glad that Montagnier had the virus, but I am certain that there was
no place in the world which was more ready to analyze its import and prove
that it was the causative agent of AIDS than Gallo's laboratory. He had
all the pieces in place; he had all the machinery to analyze new retroviruses,
and it was what he had been trying to do for fifteen years. His people,
namely Mika Popovic, learned how to grow it. Once they knew how to grow
it and make enough of it to get reagents to study, then they knew what
tests to do. That was the one place in the world where it needed to be
to get things done fast. There is no question about that.

Harden: Do you think that the [John] Crewdson articles are tilting at
the wrong windmill and, in a sense, splitting hairs or is there some justification
for them?

Gelmann: Crewdson was trying to
analyze personal behaviors, individual actions at particular times of
some day of a week, and make a pattern or make some understanding of it.
I am not sure I can understand those events in the same way that Crewdson
did. Science works in funny ways, and a lot of it is opportunism. However,
the sinister and conspiratorial aspects of Crewdson's account are perceived
and were not real. If Bob Gallo gets the Nobel Prize, which he should,
it will not be the first time someone, whom other people think to be difficult,
wins the Nobel Prize. That is part of life. Mika Popovic had spent twenty
years working with retroviruses. He came from the institute in Prague,
one of the cradles of retrovirus research. Sitting in his little back
room, he applied techniques that were twenty years old, trying to grow
this thing. In a very ancient and European way, he would puff on his pipe,
put his pipe down, and do some work and pick his pipe up again. The biohazard
people would have shot him. But he was involved in a critical breakthrough
in terms of growing viruses.

In fact, at that time virus stocks were just not available. Making enough
for anyone to prove it and to figure out what it was meant learning how
to grow it. The French did not know how to grow it. They grew it in culture
on fresh cells, and the virus did what it was supposed to do and killed
the cells. So every two weeks they had to start their cultures all over
again and they were never able to collect any and save it for the winter.
Popovic derived the cell line that was resistant to killing by the virus.
Therefore, you could grow and produce the virus and you could collect it
in studies–protein studies, nucleic acid, make antibody tests out
of it, and so on. There were all the people in place to do the mass testing,
to take the blind samples from the CDC and prove the association. Gallo's
laboratory was ready to do that.

Harden: It sounds as though
Dr. Gallo's personality becomes the focus for a lot of people.

Gelmann: Throughout
his career.

Rodrigues: I think that part of the problem people seem to have is that
they expect physicians in particular, and probably scientists in general,
to be individuals who are somehow beyond those weaknesses and frailties
that we see in others. We are unforgiving when we see such things in them.
The expectation is that someone in that kind of position is more than
human.

Gelmann: It
is hard to meet those expectations.

Rodrigues: One of the things you mentioned before was about how the AIDS
patients and the AIDS activists helped not only their own cause but also
other types of patient areas. Has any of the activism about AIDS hampered
any effort or discouraged people from becoming involved in the research?
It seems as if the federal researchers particularly, if you read some
of the articles, were cast as villains by some of the more extreme activists.